OSCE OSCE Neurological Assessment 5 — Questions and Answers
Question 1: A patient with Parkinson's disease is asked to walk across the room. Which gait abnormality would you most likely observe?
- High-stepping steppage gait
- Wide-based ataxic gait
- Shuffling gait with reduced arm swing and festination (Correct answer)
- Scissor gait with adducted legs
Correct answer: Shuffling gait with reduced arm swing and festination
Parkinson's disease produces a shuffling, festinating gait with reduced arm swing, stooped posture, and difficulty initiating movement due to basal ganglia dysfunction.
Question 2: During a neurological OSCE, you test for the presence of clonus at the ankle. Sustained clonus (>5 beats) most likely indicates:
- Lower motor neuron lesion
- Peripheral neuropathy
- Upper motor neuron lesion (Correct answer)
- Anterior horn cell disease
Correct answer: Upper motor neuron lesion
Sustained clonus indicates pathological hyperreflexia due to an upper motor neuron lesion releasing inhibition on the stretch reflex arc.
Question 3: A patient demonstrates pronator drift when asked to hold arms outstretched with palms up and eyes closed. What does this indicate?
- Sensory ataxia from posterior column loss
- Subtle contralateral upper motor neuron weakness (Correct answer)
- Ipsilateral cerebellar dysfunction
- Peripheral motor neuropathy
Correct answer: Subtle contralateral upper motor neuron weakness
Pronator drift occurs when subtle corticospinal tract weakness allows the arm to pronate and drift downward, indicating a contralateral UMN lesion.
Question 4: When performing the NIHSS in a stroke OSCE scenario, which domain assesses visual fields?
- Item 2 — gaze
- Item 3 — visual fields (Correct answer)
- Item 4 — facial palsy
- Item 5 — motor arm
Correct answer: Item 3 — visual fields
NIHSS Item 3 assesses visual fields in each quadrant using confrontation, scored 0 (normal) to 3 (bilateral blindness).
Question 5: A patient has loss of pain and temperature from the level of T4 bilaterally with preserved proprioception. Which spinal cord syndrome best explains this?
- Anterior cord syndrome (Correct answer)
- Central cord syndrome
- Brown-Séquard syndrome
- Posterior cord syndrome
Correct answer: Anterior cord syndrome
Anterior cord syndrome causes bilateral loss of pain and temperature (spinothalamic tracts) while preserving dorsal column function (proprioception and vibration).
Question 6: During the OSCE, you test two-point discrimination on the fingertip. Normal two-point discrimination at the fingertip is approximately:
- 1–2 mm
- 3–5 mm (Correct answer)
- 6–8 mm
- 10–12 mm
Correct answer: 3–5 mm
Normal fingertip two-point discrimination is 3–5 mm, reflecting the high density of mechanoreceptors; on the back it may be 40–70 mm.
Question 7: A patient presents with sudden bilateral leg weakness, saddle anaesthesia, and urinary retention. Which neurological emergency does this describe?
- Multiple sclerosis relapse
- Cauda equina syndrome (Correct answer)
- Transverse myelitis
- Anterior cord syndrome
Correct answer: Cauda equina syndrome
Cauda equina syndrome presents with saddle anaesthesia, bilateral lower limb weakness, and sphincter dysfunction requiring emergency MRI and surgical decompression.
OSCE OSCE Neurological Assessment 5
A patient with Parkinson's disease is asked to walk across the room.
Which gait abnormality would you most likely observe?